PHD-Department of Foods, Nutrition & Dietetics

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Effect of Moringa-Finger Millet Porridge Consumption on Protein and Vitamin A Status of Cerebral Palsy Children in Nairobi City County, Kenya
(2022) Malla, Janet Kajuju; Sophie Ochola; Irene Ogada
Malnutrition, secondary to feeding dysfunctions is common in children suffering from Cerebral Palsy (CP) and is associated with inadequate protein intake which is consequently linked with vitamin A deficiency. A diet that is both nutrient-dense and easy to chew and swallow is necessary to improve the protein and vitamin A status of these children. Previous studies have reported the potential of Moringa oleifera leaf powder in alleviating nutritional deficiencies. The purpose of this study was to find out the effect of M. oleifera consumption on the protein and vitamin A status of children with CP. Phase one involved the development, nutrient analysis and sensory evaluation of a fermented finger millet porridge fortified with M. oleifera leaf powder for the intervention. The second phase was a randomized clinical controlled trial with a sample of 113 children with CP randomly allocated to 2 study groups (intervention and control) on a 1:1 ratio. Participants in the control group were fed on fermented finger millet porridge while those in the intervention group received the fortified porridge daily for 3 months. Data collection was done by interviewing caregivers on socio-economic and demographic characteristics and dietary intake of children with CP. Nutrisurvey was used to determine the nutrient intakes of the study children which were compared against RDA values. Anthropometric measurements of children (weight and height) were also taken. The nutritional status of the children was expressed in terms serum albumin and retinol levels as well as BMI-for-age Z-scores and interpreted using WHO Child Growth Standards (2006). The Statistical Package for Social Sciences (SPSS) was used for data analysis. Relationships between categorical variables were determined using Chi-square tests while independent t-test was used to compare continuous variables. The significance level was set at p≤0.05. Results indicated that M. oleifera leaf powder had significantly high content of Protein and b-carotene which were target nutrient components for fortification of the fermented millet flour. M. oleifera fortified porridge was significantly more organoleptically acceptable than the non- fortified porridge [t (52) = 2.994; p = 0.004]. At baseline, the serum albumin levels for both groups were lower than the normal range of 3.5-5.0g/dl i.e. (3.067g/dl for intervention and 3.186g/dl for control), representing general protein deficiency. Serum retinol levels for both groups were also below the cut off values of 0.7 μmol/L i.e 0.471 μmol/L for intervention and 0.468 μmol/L for control). At end line, significant differences were observed between the control and intervention study groups respectively in the levels of serum retinol (0.471+0.03 and 0.714+0.03 μmol/L, p<0.001), serum albumin (3.198±0.06 and 3.523±0.07 g/dL, p=0.001). The BMI-for-age Z-scores between the two study groups were significantly different at end line (p=0.037) with fewer children in the intervention group found to be underweight at end line. The consumption of M. oleifera fortified porridge highly significantly improved the serum retinol and albumin levels and also the BMI-for –age Z-scores in the children in the intervention group. The study thus confirms that M. oleifera has potential of being used as suitable natural fortificant for foods consumed by children with CP in order to improve their nutritional status.
Development and Validation of a Competency-Based Education Model for Strengthening Undergraduate Training in Human Nutrition and Dietetics in Uganda
(Kenyatta University, 2022) Kikomeko, Peterson Kato; Sophie Ochola; Irene Ogada; Archileo N. Kaaya
Human Nutrition/Human Nutrition and Dietetics (HN/HND) training in Uganda follows the traditional credit system of education, a system criticized for inadequately equipping graduates with the requisite competencies for health systems performance. Competency-based education (CBE) is advocated to improve the competency of health professionals for health systems performance. However, the competencies expected of HN/HND graduates are undefined in Uganda limiting undertaking CBE for the profession. This study aimed to develop and validate a CBE model suitable for strengthening undergraduate HN/HND training in Uganda under four main objectives: to determine the nutrition/dietetic needs in Uganda; to establish the competencies required of HN/HND graduates for health systems performance in Uganda; to assess the current scope of HN/HND training and practice in Uganda; and to develop and validate a competency-based education model suitable for teaching HN/HND at the undergraduate level in Uganda. This study used a cross-sectional mixed method and was undertaken in two phases from December 2017 to June 2020. The first phase (competency needs assessment) targeted 450 HN/HND graduates, 14 HN/HND academic staff, and 11 HN/HND employers/internship supervisors. Data from graduates were collected using a cross-sectional email-based survey; while that from other participants were through face-to-face interviews. The second phase (model development and content validation) had three stages; validation workshop, focus group discussion, and consensus development undertaken in two modified Delphi rounds. The workshop had 31 participants, the focus group had eight; the first and second modified Delphi rounds had 70 and 55 respectively. Graduates' responses from the first phase were coded in Microsoft Excel Professional Plus version 10, emerging themes and sub-themes were quantitized, and descriptive and multiple response analyses done using IBM Statistical Package for Social Scientists version 20. Other participants‘ responses, coding, and content analysis were done using NVivo 12 Plus software. For data from the modified Delphi study, content analysis and analysis of percentage responses were done in Microsoft Excel Professional Plus version 10 with participant consensus for each statement set at ≥80%. Of the 450 targeted graduates, 132 responded to the needs assessment phase, 64.4% of these, and 64.3% of academic staff were females. 63.6% of the work/internship supervisors were males. Generally, results show that respondents viewed communities as facing multiple nutrition/dietetics challenges; graduates were expected to possess diverse competencies but had competency gaps even in core areas. Undergraduate HN/HND curricula differed across universities; besides accreditation of universities and their curricula, mechanisms for regulation, registration, and certification of HN/HND graduates were slowly established. In the second study phase, a HN/HND competency-based education model framework was developed and validated. It comprised seven domains, 22 subdomains, and 153 competency statements evaluated as both relevant and suitable for undergraduate HN/HND training in Uganda. The study recommends evaluating the extent to which HN/HND curricula in Uganda‘s Universities address the competencies comprised in the developed CBE model; translating the developed CBE model into a standard curriculum that can be taught and evaluated; and assessing Uganda‘s higher education institutional capacity readiness to offer CBE in HN/HND.
Effect of Nutrition and Physical Activity Education Intervention on Weight Management among Adolescents in Secondary Schools in Uasin Gishu County, Kenya
(Kenyatta University, 2021) Munyao, Florence Wandia; Sophie Ochola; Irene Ogada
Health-related behaviors and attitudes, such as unhealthy eating habits and physical inactivity have been identified as key causative factors of overweight and obesity. Studies to evaluate school-focused interventions on weight management in adolescents in Kenya are limited. The purpose of this study was to determine the effect of a school-focused nutrition and physical activity education intervention on the knowledge, attitudes, dietary patterns and physical activity patterns in relation to body weight among adolescent students 15-18 years old attending day schools in Kenya. This was a Cluster Randomized Controlled Trial in which 4 schools were randomly placed into 2 study groups. Students were randomly assigned to the study groups; 111 per group. The intervention group received 8 lessons each of nutrition education and physical activity education on a weekly basis. Students in the control group received no nutrition and physical activity education lessons from the research team. Data was collected using self-administered questionnaires at baseline, 8 weeks and 6 months post intervention. Key informant interviews were conducted to collect qualitative data. Major dietary patterns were derived from a principal component analysis of reported intake from a Food Frequency Questionnaire. Data was analyzed by use of statistical package for social sciences (SPSS) version 21 for descriptive and inferential statistics. Nutrition and physical activity education resulted in significantly higher improvement in mean knowledge scores in intervention group compared to the control group (T-test: 2.269; p=0.024) at 6 months post intervention. The difference in knowledge change (difference in difference) in the intervention group was significantly higher than the difference in the control group (DID of 0.43; p<0.001). The students mean attitude scores were significantly different at 6 months post intervention (T-test:-6.47; p<0.001). The principal component mean of the healthy dietary pattern was significantly higher in the intervention group compared to the control group (T-test: 1.814; p=0.042). The intensity and levels of physical activity improved in the intervention group as compared to the control group at 8 weeks and 6 months post intervention. Metabolic Equivalent for Task (MET) scores were significantly higher in the intervention group (T-test: -2.36; p=0.019) at 6 months post intervention as compared to the control group. The intervention group had a significantly lower waist circumference at 8 weeks post intervention compared to the control group (T-test: 3.229; p =0.001), but the mean BMI for age Z scores were not significantly different at the same time period (T-test: -0.357; p=0.720), between the study groups. The intervention group had lower mean waist circumference and lower mean BMI for age Z scores in contrast to the control group, at 6 months post intervention. Significant changes in the mean scores of waist circumference (Difference in Difference (DID) of 1.16; p<0.001) and mean BMI for age z scores (DID of 0.66; p<0.001) were noted when baseline and end line mean scores were compared. School focused physical activity and nutrition education can be effective in managing weight among adolescent students and should therefore be encouraged.
Impact of Maternal Dietary Intake on Breast Milk Composition and Infant Nutrition Status Among Lactating Women in Nyeri County, Kenya
(Kenyatta University, 2020-08) Kiboi, Willy Kahanya
Exclusive breastfeeding for the first six months of life, with continued breastfeeding up to 2 years after the introduction of complementary feeds, is considered as the standard norm for infant feeding. Although the benefits of breastfeeding have long been known, studies on the composition of human milk are still ongoing. Considering that breast milk is the sole source of the nutrition for the infant in the first six months of life, it is essential to have accurate and up to date data on its composition. The composition of human milk could vary according to many maternal factors such as diet, nutritional status, genetics and environmental exposures, among other factors. The amount of variability in human milk composition that could be attributed to maternal dietary intake remains largely unknown. In Africa, particularly in Kenya, there is scanty information available on the nutrient composition of breast milk and the factors that affect its composition. This study therefore investigated the association between maternal dietary intake with breast milk nutrient composition and their effect on the nutrition status of the infant (under six months). The longitudinal study was conducted in Nyeri County, Kenya. Participants included lactating mothers with infants under six months. The lactating mothers’ dietary intake, nutrition status (BMI, MUAC and serum micronutrients) and that of their infants (recumbent length and weight) were assessed. Additionally, breast milk samples were collected and analyzed for selected nutrient content and correlated with both maternal dietary intake and the infant’s nutritional status. The breast milk samples were analysed for energy, macronutrients and selected micronutrients (vitamin A, calcium, magnesium, zinc and iron). All the measurements were done at two time points (first and the fifth month of lactation) among a comprehensive sample of 104 mother-child dyads. Significant changes in the mean nutrient composition were noted between the first and fifth month of lactation (protein-0.96 g/dL and 0.85 g/dL, p = 0.03; vitamin A-22.48 and 31.61 μg/dL, p value, p < 0.001; iron-0.39 mg/L and 0.47 mg/L, p = 0.02). There was statistically significant (p < 0.05) relationship between mother energy intake with milk lactose (r = 0.30); carbohydrate intake with milk true proteins (r = 0.24); protein intake with milk true protein (r = 0.44) and milk iron (r = 0.31); fat intake with milk energy (r = 0.29), milk true protein (r = 0.40) and milk fat (r = 0.35); percent of energy from fat with milk energy (r = 0.39) and milk fat (r = 0.45). Furthermore, vitamin A intake with milk retinol (r = 0.56), calcium intake with milk zinc (r = -0.32) and iron (r = -0.27), zinc and iron (r = -0.26). For maternal nutrition status, hemoglobin (Hb) was correlated with both milk energy (r = 0.30) and true protein (r = 0.44). Serum retinol, magnesium and iron were correlated with milk retinol (r = 0.34), magnesium (r = 0.29) and iron (r = 0.33), respectively. Association between breast milk nutrient composition and infant nutrition status revealed that the milk true protein (r = 0.58) and retinol (r = 0.32) were positively correlated with weight for age and MUAC (r = 0.31) of the infant. Weight for length was also positively correlated with milk lactose (r = 0.47). No relationship was found between other maternal factors (age, parity, child sex and mode of delivery) and any of the selected breast milk nutrient content (p > 0.05). The study observes that breast milk nutrient composition is variable over the course of lactation. Further, both maternal dietary intake and nutrition status (serum micronutrient status) are associated with the nutrient composition of human milk. Moreover, breast milk nutrient composition is related to the infant nutrition status. Promoting adequate nutrient intake and optimal maternal nutritional status during lactation is essential to ensure adequate child growth and development.
Effect of Umbilical Cord Clamping Time on Nutrition Status of Infants: A Randomized-Controlled Trial in Longisa Hospital, Bomet County, Kenya
(Kenyatta University, 2019-10) Bor, Kipkorir Wesley
Although most studies document the benefit of delaying umbilical cord clamping in relation to improved haemoglobin levels, few of those studies have been done in low resource settings. Standard routine practice in most facilities is generally clamping umblical cord in less than 60 seconds. This study therefore sought to establish the effects of umbilical cord clamping time on infant nutritional status at 6 months at Longisa County Referral Hospital through randomized controlled trial design. Sample size of n=204 of mother-infant pair was enrolled in both control and experimental group of the study. The experimental group involved clamping the umbilical cord between 3-5 minutes after delivery while the control group was clamped as per the standard routine practice in the facility. Infant’s blood sample was drawn and haemoglobin was assessed at birth, 6 weeks and 6 months. Ballard maturity assessment score was used to assess infant gestational age at birth. Weight was measured using SECA 354 and length was assed using SECA 210 length Matt. Mother -infant socio demographic characteristics collected using a validated questionnaire. A standard Pre-test questionnaire based on WHO 2014 guidelines was used to measure health workers knowledge on the umbilical cord clamping time. Data was analysed using Stata version 15.1 and Microsoft Office Excel 2007. Mother-infant socio-demographic characteristics by the study group was compared using Pearson chi-square (p < 0.05; 95% CI). Health workers’ knowledge was analysed results presented in percentage. Third trimester maternal haemoglobin was collected in mother child booklet and analysed using Pearson chi-square. Infant haemoglobin levels at birth, 6 weeks and 6 months by study group was analysed using Pearson chi-square. The relationship between maternal and infant haemoglobin status was assessed using Pearson correlation coefficient determinant. The effect of umbilical cord clamping on infant nutritional status and haemoglobin was tested using student t-test. Predictors of infant Nutritional status at six (6) months were established using binary logistic regression model. The results are based on two-tailed tests at 95% confidence interval and a p-value p < 0.05 was used as the criterion for significance. Results were: Mean age of mothers of infants enrolled into the study was (22.73 ± 1.9; p<0.05); about 50% of health workers knew that delaying umbilical cord clamping is beneficial to the infant. Approximately 69% of health workers believe that delaying umbilical cord camping increases the HIV infection. Control group: Mean weight: at birth 2.89kgs (95% CI, 2.81-2.97), 4.81 (95% CI (4.68-4.94) at 6 weeks and 7.41kgs (95% CI, 7.28-7.54) at 6 months. Mean haemoglobin at birth was 18.72g/dl (95% CI, 18.19-19.25), 10.85g/dl (95% CI (10.58-11.12) at 6 weeks and 11.10g/dl (95% CI, 14.26-15.52) at 6 months. Experimental group: Mean weight at birth 2.93kgs, 5.22 (95% CI, 4.99-5.22) and 8.51 at 6 months ((95% CI, 8.40-8.60; p<0.05). Mean haemoglobin: Birth 19.67g/dl, (95% CI, 19.25-20.09), 11.72(95% CI, 11.45-11.99) and 12.22g/dl (11.95-12.49 at 6 months ((95% CI, 8.40-8.60; p<0.05). Predictor of infant nutritional status at 6 months were weight (OR14.90, p<0.05; 95% CI: 7.25-30.00) and infant haemoglobin (OR1.64, p<0.05; 95% CI: 1.3-2.07). The study concluded that delaying the umbilical cord clamping improved infant Nutritional status and haemoglobin. Setting optimal time to clamp the umblical cord is important for Kenyan health facilities.
Efficacy of Psycho-Educational Nutrition Initiative on Energy and Micronutrient Intake, Physical Activity and Pregnancy Outcomes in Migori County, Kenya
(Kenyatta University, 2019-03) Oyeho, Florence A.
A large number of pregnant women in many parts of the world enter pregnancy at sub-optimal weight and height. A third of Kenyan population suffer from food insecurity that is further complicated by factors such as adverse weather conditions and increases in food prices. The result is malnutrition which primarily affects pregnant women and children under five years and significantly contributes to their morbidity and mortality. Maternal nutrition is critical for both mother and child as it lays fundamental foundation for the successful outcome of pregnancy. Kenya’s high rate of undernutrition among women of reproductive age are due to sub-optimal feeding practices, heavy workload, inadequate micronutrient intake and insufficient awareness and knowledge on nutritionally adequate diets among pregnant women leading to preterm births, low birth weight, high mortality and morbidity, impaired growth, and increased risks during childbirth for both mother and child. This study sought to investigate socio-demographic characteristics, determine nutrition knowledge and health conditions and effect of nutrition educationon nutrition knowledge and dietary practices, assess energy and micronutrient intake, determine physical activity levels, and determine pregnancy outcomes and associations between psycho-educational nutrition initiative and nutrient intake, physical activity and pregnancy outcomes among pregnant women in Migori County. A prospective cohort study design was used and simple random sampling was used to obtain a sample of 150 pregnant women from three sub-county hospitals purposively selected for study. Pregnant women of GA ≤26 weeks were recruited and enrolled into psychoeducational nutrition intervention study. Data was collected by 24 hour recall, International Physical Activity Questionnaire, biochemical analysis, anthropometric measurements and secondary data. Data was collected at baseline and after intervention for each woman and analyzed by Nutri-Survey computer package, IPAQ scoring protocol and SPSS. Data was summarized by descriptives and relationships between variables was tested by Chi square, regression model and pearson’s product moment correlation.ANOVA and t-tests were used to test for differences between means. Findings showed that the pregnant women were of low economic status. Nutrition education had positive significant associations with nutrition knowledge and practices. Most women had good health with on conditions interfering with their food consumption. Generally, there was improved dietary intake of all nutrients after the intervention although some did not meet the RDA even after intervention There was a slight reduction in physical activity factors and increased time for rest was observed after intervention although there was no significant reduction in activity levels (p ≤ 0.05). Weight gain (5.98 kg) was lower than recommended, mean gestation age was normal (37.74 weeks) but lower for preterm births category and mean BW (3039±489.5 g) was normal although 7% of new bornes had LBW. The study found significant effects of nutrition knowledge from the psycho-educational initiative on nutrient intake and pregnancy outcomes but found no effect on physical activity. The study concludes that nutrition education can be used to enhance pregnancy outcomes and nutrient intake among pregnant women. The finding is important to central and county governments, civil society, intergovernmental agencies, research groups, business enterprises and community under study.
Effect of Nutrition Education on Complementary Feeding Practices and Nutrition Status of Infants: A Cluster Randomized-Trial in Ondo State, Nigeria
(Kenyatta University, 2019-06) Remilekun, Akinrinmade
Malnutrition during infancy has been linked to lack or poor knowledge of appropriate feeding practices among caregivers. This study investigated the effect of nutrition education on adequate complementary feeding practices among caregivers as well as the nutrition status of infants (5-11months) in Ondo State, Nigeria. The study adopted cluster randomized controlled trial design. The study participants were assigned to two groups. One intervention and one control group in a ratio of 1:1. The sample size was 142 for intervention group and 142 for the control group. Nutrition education on complementary feeding was carried out among the caregivers in the intervention group and the control group received no nutrition education from the research team. The participants in the intervention group received four (4) lesson sessions per group. The lesson sessions were based on timely introduction of complementary feeding, meal frequency and planning, dietary diversity, minimum acceptable diet, hygiene and responsive feeding. To determine the complementary feeding knowledge, attitude and practices of the caregivers as well as the nutrition status of the infants, data were collected from caregivers at the infants’ age 6, 8 and 11 months. For knowledge and attitude, complementary feeding knowledge and attitude based questionnaire were used. For complementary feeding practices, 24-hr dietary recall was used and nutrition status assessment instruments were used to determine the infants’ nutrition status. Focus group discussions and key informant interviews were conducted for qualitative data. Data were analyzed using SPSS version 22.0. From the analysis, there was no significant difference in demographic and socio-economic status of the caregivers. There was a significant difference in the complementary feeding mean knowledge score of the caregivers after the intervention at the endline (4.0; p<0.001) and the (Difference in Difference (DID) between baseline and the endline was 4.06 (p<0.001) and the complementary feeding mean attitude score of the caregivers was 3.82; p<0.001) at the endline. The mean nutrients intake of the infants in the intervention group was higher than the control group as analyzed by nutri-survey. The mean energy intake of infants in the intervention group was higher both at the midline (259g±20.67) and at the endline (366.7g±23.03) than those in the control group both at the midline (121.1g±17.05) and the endline (212g±22.04), these were both significant (p<0.001). From Kaplan-Meier analysis, continued breastfeeding survival at age 11 months was 94.4% in the intervention group and it was 69.7% in the control group (p<0.001). Adjusted Relative Risk (ARR) was used to determine the effect of nutrition education on the intervention group and control group for variables such as Minimum Acceptable Diet (ARR: 3.13; CI:2.53-5.16; P<0.001) at the endline. There was a significant difference in WAZ (t.test; p<0.001), WHZ (t-test; p<0.001) and in HAZ (t-test; p=0.049). The infants in the intervention group had improved nutritional status than the infants in the control group. This study concluded that nutrition education based on complementary feeding guidelines improved the feeding practices of the caregivers. Therefore, the study recommends that Ministry of Health in Ondo State should encourage complementary feeding training for caregivers and CHEWs at the various Basic Health Centers in the State.
Effect of iodine exposure on blood pressure among female children and women in Kathonzweni, Makueni, Kenya
(Kenyatta University, 2018) Bukania, Zipporah Nekesa
High or raised blood pressure (HBP) is a global public health issue and a major cardiovascular risk factor. While the Kenya StepWise survey of 2015 confirmed that more than half (56%) of Kenyans have never been screened for BP, renewed interests in hypertension in children and adolescents has resulted from the recognition that its presence in adults often has its roots at a younger age. It is also still controversial whether mild thyroid dysfunction affects BP. To understand if iodine status affects blood pressure, A two- arm treatment; two periods’ double-blind cluster randomized crossover study comparing the effect of low and high iodine in salt (within the iodization regulation levels) in women of reproductive age and school age girls (8-12years). Participants in clusters randomized to one of the two sequence groups: Arm1-(H2L) started with high iodine(50mg) in salt and changed to low iodine in salt after 3 weeks) while Arm2-(L2H) (started with low iodine (30mg) in salt and changed to high iodine in salt after 3 weeks – without wash out period). 171 women-girl pair participants were assessed for family history of chronic disease, age, level of education and anthropometrics. Urinary iodine, sodium, potassium, lithium and blood pressure were assessed weekly. Data were analysed using SPSS version 20.0. Student unpaired two sample t-test was used to compare the difference in BP levels while differences in the distribution of independent variables (low (30mg) and high (50mg) iodine intake) between groups was determined using Pearson’s chi-square or Fisher’s exact test for categorical variables. Coefficient of dispersion was used to understand the spread of lithium as a marker of intake while analysis of covariance using univariate General Linear Model was used to estimate the effect of the treatment adjusting for specific covariates identified to be significantly different between the two intervention arm sequences at baseline. In women, the total effect due to high dose iodine in salt was equivalent to -1.1 [95% CI: -4.0 to 1.9]; constant -2.7, (P=0.474) for Systolic Blood Pressure (SBP) and -3.7 [95% CI: -6.0 to -1.3] constant 1.03 (P =0.003) for Diastolic Blood Pressure (DBP). Regression analysis of treatment on BP showed a significant adjusted effect of high dose iodine in salt on DBP (P=0.001) but not SBP (P=0.474). The variability of the difference in SBP and DBP attributable to treatment was 0.4% and 8.1% respectively. In school age girls, the total effect due to high dose iodine in salt was equivalent to -1.68 [95% CI -4.49 to 1.12], (P=0.237) for SBP and -4.48 [95% CI -7.66 to -1.29] (P =0.006) for DBP. Univariate covariance analysis in General Linear Modelling showed statistically significant effect of treatment on DBP f=6.83, (P=0.010) but not for SBP f=1.38, (P=0.242) in the girls. General Linear regression on the net adjusted effect attributable to the treatment showed that the high dose of iodine was negatively associated with both SBP and DBP resulting in a positive role in lowering blood pressure in both girls and women. While salt is the main source of iodine, it is also known that sodium in the edible salt is also responsible for HBP worldwide. These findings highlight an inverse relationship between BP and Iodine intake. High iodine intake decreased BP. There is need for further in-depth research on the iodine and BP linkage and to understand whether restricting iodized salt intake may cause a decrease in iodine intake and could worsen HBP, rather than control it.
Bioequivalence of Micronutrient Powders to Conventional Fortification on Zinc Status of Children Aged 6-36 Months in Thika Informal Settlements, Kenya
(Kenyatta University, 2016-11) Kiio, Juliana N.
Corn Soy Blend (CSB) is the backbone of supplementation feeding for malnourished children. CSB however, has poor micronutrient bioavailability and may result into poor outcomes during nutrition recovery of the children. Micronutrient powders (MNPs) have a potential to improve micronutrient nutrition. Scientific evidence on the efficacy of MNPs in improving zinc (Zn) status among moderately malnourished children is scarce. This cluster randomized trial was designed to establish the bioequivalence of MNPs formulated as sprinklestm to conventional fortification in improving Zn status of moderately malnourished children aged 6-36 months in Thika informal settlements, Kenya. Secondary objectives were to determine the effect of Zn fortification on growth velocity, appetite and morbidity, to assess the predictors of Zn status at baseline and to establish the in vitro bio-accessibility of Zn. Twelve villages were randomized to four study groups. Three experimental groups received different formulations of MNPs added to CSB; multiple micronutrients (MMN) containing Zn (CSB-sprinkle-MMNZn), MMN without Zn (CSB-sprinkle-MMN) and Zn singly (CSB-sprinkle-Zn). The control group received conventionally Zn-fortified CSB containing MMN. CSB was prepared centrally in each of the participating villages and enrolled children brought there and fed daily on the assigned formulation. Standard tools were used to collect socio-demographic characteristics. Dietary practices were assessed using 24-hour recall and Food Frequency Questionnaires. Enrolled children underwent physical examination and anthropometric measurements. Hair and serum Zn levels were determined pre-post intervention. Daily consumption of CSB was monitored for a period of six months with monthly follow-up on dietary intake, anthropometric measurements and morbidity patterns. Sample size was calculated to show bioequivalence within ±20% limit. A total of 346 children (MUAC ≥11.5 - <12.5cm) were enrolled following informed consent; CSB-sprinkle-MMNZn (N=84), CSB-sprinkle-MMN (N=88), CSB-sprinkle-Zn (N=93) and control group (N=81). Analysis was by intention-to-treat. Strict adherence to assigned groups was observed and groups were similar in loss to follow-up and baseline characteristics except for a few differences. At baseline, 64.2% of the children were Zn deficient, Zn intake was sub-optimal for 95.7% of children. The prevalence of diarrhoea, acute respiratory tract infections and fever was 45.4%, 16.8% and 17.6% respectively. A mixed effects linear regression was used to model pre-post change in serum Zn levels, adjusting for age, sex and socio-economic status. Compared to control group, the change was significantly lower for CSB-sprinkle-MMN (β= -20.0μg/dL; 95% CI: -26.5, -13.5) and significantly higher for CSB-sprinkle-MMNZn (β=5.9 μg/dL; 95% CI: 0.5, 11.3). No significant difference was observed between CSB-sprinkle-ZN and control group (β=-2.1; 95% CI: -8.3; 4.2). Conventional fortification was not bioequivalent to MNPs in improving serum Zn levels (t-tests 95% CI: -2.2; 8.9 p>0.05). Kaplan Meier disease-free survival was not significantly different among study groups (log rank test; p>0.05). Change in appetite scores was not significantly different among study groups (mixed effects linear regression; p>0.05). In vitro Zn bio-accessibility in MNPs (26.05%) was not significantly different from control (24.07%) (t-test; p=0.7). MNPs were more effective in improving Zn status of malnourished children compared to conventional fortification and are therefore recommended for food supplementation programmes targeting urban poor. Further research on processing technologies to improve micronutrient bioavailability in CSB and on optimal home fortification for improved health outcomes is needed.
Impact of spirulina corn soya blend on protein energy malnourished and iron deficient children aged 6-23 months in Ndhiwa sub-county-Kenya.
(Kenyatta University, 2016-12) Othoo, Dorothy Apondi
Protein Energy Malnutrition (PEM) and iron deficiency Anemia (IDA) affect children below five years globally. Studies in Kenya show levels of stunting (26%), wasting (4%), underweight (11%) and low iron intakes (7%) among children aged 6-23 months. These children are at critical period of rapid growth marked by malnutrition which can be irreversible if not effectively addressed. The standard CSB to manage PEM is inadequate in energy and micronutrients. Spirulina powder is richer in proteins and iron than soya bean and if used to fortify CSB would provide a more energy dense and iron rich flour than standard CSB. The SCSB can be produced locally by households to ensure nutritious consumption for under-nourished children than CSB. The objective of the study was to determine impact of SCSB on PEM and IDA among children aged 6-23 months in Ndhiwa Sub-County through a randomized controlled trial. A total of 240 children with PEM and IDA were accessed at Ndhiwa Sub-County Hospital and randomly assigned to two experimental groups (EG1 received SCSB while EG2 received standard CSB) and one control group who did not receive any treatment during the intervention. Data was collected using a questionnaire and a Focus Group Discussion (FGD) guide. PEM was assessed using the following indicators; plasma Retinol Binding Protein, WHZ and WAZ scores while iron status assessed based on Hematocrit levels. Relative Risk, Difference in Difference and Log-rank tests were used to compare impact of SCSB and standard CSB on PEM and IDA while logistic regression used to identify predictors of plasma RBP, Hct levels, WHZ and WAZ. At baseline, assessment of plasma RBP and Hct levels was done. In addition nutrient content analysis of spirulina powder, SCSB, CSB and maize flours was done for carbohydrates, proteins, fats and iron, and production of SCSB and CSB flours used in the intervention. Intervention was done for 6 months and involved daily consumption of 100g SCSB and CSB flours while doing assessments of key variables up to six months. The SCSB was significantly higher in energy (5.4±0.1Kcal/100g vs 2.9±0.7 and 2.8±0.3, p=0.036), protein (20.84±0.2 vs 15.47±0.2 and 0.06±0.1, p=0.043) and iron (15.32±0.2 vs 6.15±0.3 and 0.81±0.2, p=0.043) than CSB and maize meal. The children who consumed SCSB significantly improved in RBP status (RR:3.07;CI:2.62-2.72,p=0.004 and RR:4.06;CI:3.63-3.76,p=0.0001), Hct status (RR: 3.15;CI:1.91-2.07,p=0.002 and RR:4.07;CI:3.66-3.79,p<0.0001), wasting (RR:3.10;CI:0.001-0.48,p=0.0001 and RR:4.08;CI:3.37-3.58,p=0.0001) and underweight (RR: 3.16;CI:3.58-3.91,p=0.0001 and RR:4.18;CI:3.05-3.27,p=0.0001) compared to children who consumed CSB and those in control group. The children who consumed SCSB had faster recovery from PEM and IDA compared to children who consumed CSB and children in control group. The breast fed children consuming SCSB were significantly meeting RDAs for energy (913.8±149Kcal vs 727.8±125 and 654±114,p=0.011 ), protein (15.2±8g vs 8.9±3 and 8.2±2, p=0.004) and iron (15.9±0.3mg vs 6.0±0.7 and 4.3±0.8, p=0.004) as well as non-breastfed; energy (832±116Kcal vs 781±93 and 652±102, p=0.022), protein (19.9±8 vs 8.3±3 and 6.2±4, p=0.001) and iron (15.9±0.1 vs 7.1±0.2 and 4.9±0.6, p=0.002) compared to children who consumed CSB and those in control group. There were no significant difference in the acceptability attributes of mothers/caregivers of children who consumed both SCSB and CSB porridges (chisquare: p>0.005). The SCSB had a significantly higher impact on PEM and iron deficiency than standard CSB and control group. The use of spirulina powder as a fortifier for commonly consumed cereals in Kenyan communities is recommended.
Impact of peanut supplementation on cardiovascular disease markers in HIV-infected adults with dyslipidemia attending Nyeri level- 5 -hospital, Kenya
(Kenyatta University, 2016-04) Wangui, Kamuhu Regina
Cardiovascular diseases (CVD) is currently second, after cancer, as the most frequent cause of death among HIV-positive subjects in areas of the world where Highly active anti-retroviral therapy (HAART) is widely available. Dyslipidemia is an important adaptable cardiovascular risk factor that is a widespread clinical feature of HIV-infected patients in the present era of HAART. Peanuts are a rich source of magnesium, folate, fibre, α- tocopherol, copper, arginine and resveratrol. These compounds have been shown to reduce the CVD risk in various ways and this suggests that peanut consumption might benefit those at risk of CVD. The purpose of this study was to investigate the effect of peanut supplementation on cardiovascular disease markers in HIV-infected adults with normal and hyperlipidemia attending comprehensive care clinic in Nyeri Level- 5- Hospital. The study design was a randomized cross-over clinical trial. The study duration was 22 weeks. The eligible participants were randomly assigned to a two arm study. In treatment I, the participants consumed their regular diet supplemented with 80g of peanuts; while in treatment II, the participants were counseled on healthy diet and supplemented it with 80g of peanut. The participants then crossed over to respective treatments. Each treatment took 8 weeks, with a six weeks washout period between treatments. Descriptive statistics were used to analyze all study variables. Relationships between all and individual CVD risk factors were analyzed using Spearman’s correlation coefficient, single line linkage and ward’s cluster method. A paired T- test was used to compare subject differences in markers at baseline and at the end of each treatment. Multiple regression analysis was used to determine the effect of peanut supplementation on CVD markers. Criterion for statistical significance was at p < 0.05 and 90% power of test. The sample comprised of 18 (21.2%) males and 67 (78.8%) females. Peanut supplementation significantly increased intake of total fat (p < 0.05), poly unsaturated fatty acid (p < 0.05), Vitamin E (p < 0.05) and mono unsaturated fatty acids (p < 0.05) while carbohydrate intake decreased significantly (p < 0.05) between baseline and the two treatments. There was no significant change in weight, BMI, waist circumference, hip circumference, body fat, body muscle, systolic and diastolic blood pressure and fasting blood glucose after consumption of peanut with regular diet and consumption of peanut combined with nutritional counseling on healthy diet. There was a significant decrease (p < 0.05) in total cholesterol, triglycerides and Low density lipoprotein in both treatments while High density lipoprotein increased significantly (p < 0.05). Also reduced significantly, was the estimated 10-year risk of coronary heart disease between baseline and end of study (p =0.03). Peanut consumption was found to lower cardiovascular risk significantly due to reduction in total cholesterol, triglyceride and Low Density Lipoprotein Cholesterol. The policy makers should promote the incorporation of this food-based supplement in order to lower the economic burden cardiovascular diseases are imposing on the economy.
Impact of Peanut Supplementation on Cardiovascular Disease Markers in Hiv-Infected Adults with Dyslipidemia Attending Nyeri Level- 5 -Hospital, Kenya
(Kenyatta University, 2016-04) Kamuhu, Regina Wangui
Cardiovascular diseases (CVD) is currently second, after cancer, as the most frequent cause of death among HIV-positive subjects in areas of the world where Highly active anti-retroviral therapy (HAART) is widely available. Dyslipidemia is an important adaptable cardiovascular risk factor that is a widespread clinical feature of HIV-infected patients in the present era of HAART. Peanuts are a rich source of magnesium, folate, fibre, α- tocopherol, copper, arginine and resveratrol. These compounds have been shown to reduce the CVD risk in various ways and this suggests that peanut consumption might benefit those at risk of CVD. The purpose of this study was to investigate the effect of peanut supplementation on cardiovascular disease markers in HIV-infected adults with normal and hyperlipidemia attending comprehensive care clinic in Nyeri Level- 5- Hospital. The study design was a randomized cross-over clinical trial. The study duration was 22 weeks. The eligible participants were randomly assigned to a two arm study. In treatment I, the participants consumed their regular diet supplemented with 80g of peanuts; while in treatment II, the participants were counseled on healthy diet and supplemented it with 80g of peanut. The participants then crossed over to respective treatments. Each treatment took 8 weeks, with a six weeks washout period between treatments. Descriptive statistics were used to analyze all study variables. Relationships between all and individual CVD risk factors were analyzed using Spearman’s correlation coefficient, single line linkage and ward’s cluster method. A paired T- test was used to compare subject differences in markers at baseline and at the end of each treatment. Multiple regression analysis was used to determine the effect of peanut supplementation on CVD markers. Criterion for statistical significance was at p < 0.05 and 90% power of test. The sample comprised of 18 (21.2%) males and 67 (78.8%) females. Peanut supplementation significantly increased intake of total fat (p < 0.05), poly unsaturated fatty acid (p < 0.05), Vitamin E (p < 0.05) and mono unsaturated fatty acids (p < 0.05) while carbohydrate intake decreased significantly (p < 0.05) between baseline and the two treatments. There was no significant change in weight, BMI, waist circumference, hip circumference, body fat, body muscle, systolic and diastolic blood pressure and fasting blood glucose after consumption of peanut with regular diet and consumption of peanut combined with nutritional counseling on healthy diet. There was a significant decrease (p < 0.05) in total cholesterol, triglycerides and Low density lipoprotein in both treatments while High density lipoprotein increased significantly (p < 0.05). Also reduced significantly, was the estimated 10-year risk of coronary heart disease between baseline and end of study (p =0.03). Peanut consumption was found to lower cardiovascular risk significantly due to reduction in total cholesterol, triglyceride and Low Density Lipoprotein Cholesterol. The policy makers should promote the incorporation of this food-based supplement in order to lower the economic burden cardiovascular diseases are imposing on the economy.
Prevalence of the female athlete triad among junior female long distance runners in Iten, Elgeyo-Marakwet County, Kenya
(2015) Muia, Esther Nduku
Adolescents regularly participating in sports and do not meet their energy intake may develop several medical conditions, such as disordered eating, menstrual dysfunction, and decreased bone mineral density, collectively referred to as the Female Athlete Triad (FAT). Limited data is available on components of FAT in adolescent athletes of African descent. This study’s aim was to investigate the presence of the components of the female athlete triad amongst a group of junior long female distance runners and non-athletes in Kenya. One hundred and ten students randomly selected from secondary schools in Iten, Elgeyo-Marakwet County, took part in this cross-sectional comparative study. Students completed demographic, health, sport and menstrual history questionnaires as well as a 5-day weighed dietary record and exercise log to calculate energy availability (EA). Heel bone mineral density was assessed with ultrasound. Subscales of the Eating Disorder Inventory and the cognitive dietary restraint subscale of the Three-Factor Eating Questionnaire measured disordered eating. Dietary intake was analysed with Nutri-survey and dietary diversity determined by the Individual Dietary Diversity Score (IDDS) using 5-day dietary records. Fewer mothers (19 vs. 40%, χ2=12.9, p=0.02) and fathers (28 vs. 50%, χ2=11.8, p=0.06) from athletes had tertiary education than non-athletes, and more mothers from non-athletes had formal employment than athletes (54 vs.13%, χ2=22, p<0.001). Energy availability was significantly lower in athletes than non-athletes (36.5 ± 4.5 vs. 39.5 ± 5.7 kcal/kg/FFM/day, p=0.003). More athletes than non-athletes were identified with clinical low EA (17.9 vs. 2 %, [OR = 9.5, 95% CI (1.17, 77), p=0.021). Subclinical (75.4 vs. 71.4%) and clinical DE behaviour was similar between athletes and non-athletes, (4.9 vs. 10.2%, respectively, χ2=1.1, p=0.56). More athletes than non-athletes had a body mass index of < 17.5 kg/m2 [16.1 vs. 0%, OR= 0.8, 95% CI (0.7, 0.9), p=0.004]. No significant differences were noted for carbohydrate, fat, calcium, magnesium, B2 and zinc intake between groups. IDDS was higher in students in day schools than in boarding schools (4.36±0.7 vs. 3.8±0.6, χ2 =13.4, p=0.001). More athletes (72.1% vs. 32.7% χ2 =17, p=0.000) reported restricting the types of food eaten and the amount to control weight (68.9% vs. 32.7%, χ2 =14, p=0.000). More athletes reported clinical menstrual dysfunction in comparison to non-athletes (32.7% vs. 18.3%, χ2=7.1 p=0.02); primary amenorrhea (13.1% vs. 2.0%) and secondary amenorrhea (19.7% vs. 10.2%). BMD tended to be higher in athletes compared to non-athletes (0.629±0.1 vs. 0.592±0.1 g/cm2, p=0.06). Kenyan adolescent athletes and non-athletes present with low energy availability and menstrual disturbances which are key components of the female athlete triad. Energy intakes should be increased in the student population to match the energy expended and menstrual disturbances closely monitored in athletic adolescent girls since exercise induced amenorrhea signals energy drain.
Prevalence of the Female Athlete Triad among Junior Female Long Distance Runners in Iten, Elgeyo-Marakwet County, Kenya
(Kenyatta University, 2015-11) Muia, Esther Nduku
Adolescents regularly participating in sports and do not meet their energy intake may develop several medical conditions, such as disordered eating, menstrual dysfunction, and decreased bone mineral density, collectively referred to as the Female Athlete Triad (FAT). Limited data is available on components of FAT in adolescent athletes of African descent. This study’s aim was to investigate the presence of the components of the female athlete triad amongst a group of junior long female distance runners and non-athletes in Kenya. One hundred and ten students randomly selected from secondary schools in Iten, Elgeyo-Marakwet County, took part in this cross-sectional comparative study. Students completed demographic, health, sport and menstrual history questionnaires as well as a 5-day weighed dietary record and exercise log to calculate energy availability (EA). Heel bone mineral density was assessed with ultrasound. Subscales of the Eating Disorder Inventory and the cognitive dietary restraint subscale of the Three-Factor Eating Questionnaire measured disordered eating. Dietary intake was analysed with Nutri-survey and dietary diversity determined by the Individual Dietary Diversity Score (IDDS) using 5-day dietary records. Fewer mothers (19 vs. 40%, χ2=12.9, p=0.02) and fathers (28 vs. 50%, χ2=11.8, p=0.06) from athletes had tertiary education than non-athletes, and more mothers from non-athletes had formal employment than athletes (54 vs.13%, χ2=22, p<0.001). Energy availability was significantly lower in athletes than non-athletes (36.5 ± 4.5 vs. 39.5 ± 5.7 kcal/kg/FFM/day, p=0.003). More athletes than non-athletes were identified with clinical low EA (17.9 vs. 2 %, [OR = 9.5, 95% CI (1.17, 77), p=0.021). Subclinical (75.4 vs. 71.4%) and clinical DE behaviour was similar between athletes and non-athletes, (4.9 vs. 10.2%, respectively, χ2=1.1, p=0.56). More athletes than non-athletes had a body mass index of < 17.5 kg/m2 [16.1 vs. 0%, OR= 0.8, 95% CI (0.7, 0.9), p=0.004]. No significant differences were noted for carbohydrate, fat, calcium, magnesium, B2 and zinc intake between groups. IDDS was higher in students in day schools than in boarding schools (4.36±0.7 vs. 3.8±0.6, χ2 =13.4, p=0.001). More athletes (72.1% vs. 32.7% χ2 =17, p=0.000) reported restricting the types of food eaten and the amount to control weight (68.9% vs. 32.7%, χ2 =14, p=0.000). More athletes reported clinical menstrual dysfunction in comparison to non-athletes (32.7% vs. 18.3%, χ2=7.1 p=0.02); primary amenorrhea (13.1% vs. 2.0%) and secondary amenorrhea (19.7% vs. 10.2%). BMD tended to be higher in athletes compared to non-athletes (0.629±0.1 vs. 0.592±0.1 g/cm2, p=0.06). Kenyan adolescent athletes and non-athletes present with low energy availability and menstrual disturbances which are key components of the female athlete triad. Energy intakes should be increased in the student population to match the energy expended and menstrual disturbances closely monitored in athletic adolescent girls since exercise induced amenorrhea signals energy drain.
Chromium supplementation in management of type 2 diabetes among patients attending Thika level 5 hospital, Kenya: a randomized placebo controlled study
(Kenyatta University, 2015) Munga, Judith
Diabetes Mellitus is a condition with common elements of hyperglycaemia and glucose intolerance. It is the fourth leading cause of death in high-income countries and evidently epidemic in newly industrialized countries as well as economically developing nations such as Kenya. Type 2 Diabetes is characterized by insulin resistance and relative insulin deficiency. Studies have reported low serum chromium levels in Type 2 diabetics compared to non-diabetic population. Chromium has been reported to potentiate insulin action in muscle cells. Studies show contradictory findings on beneficial effects of chromium on; blood sugar (FBS and HbAlc), blood lipids (LDL, HDL, triglycerides and total cholesterol), adiposity measures (BMI, WC and W/H ratio), fat mass and lean body mass. Consequently similar studies have been recommended to investigate further the benefits of chromium with a view of coming up with conclusive evidence. The purpose of this study therefore was to investigate the contribution of chromium supplementation in the management of fasting blood sugar, HbAlc, LDL, HDL, triglycerides, BMI, W/H ratio and WC in Type 2 Diabetes mellitus patients in Thika level 5 Hospital, Kenya. This was a double blind randomized controlled trial with a sample size of 180 participants on hypoglycaemic drugs. The sample was randomized into two study groups at a ratio of 1:1 (control group and intervention group). Participants in the intervention group received chromium picolinate (500mcg/day) while the control group received placebo for a period of 4 months. Data was collected at baseline, monthly and end of month 4, using semi-structured questionnaires. Information collected included: demographic characteristics, medical history, physical activity and dietary patterns. Additionally, anthropometric measurements (weight, height and waist and hip circumferences) were taken. Blood samples were analysed for chromium levels, HbAlc, serum ferritin and serum lipids (LDL, HDL, total cholesterol and triglycerides). Descriptive statistics such as mean and standard deviation were used to analyze demographic, socioeconomic, blood sugar, blood lipids and anthropometry and nutrient adequacy from 24 hour recall; mode was used to describe the 7 day food frequencies. Principle component analysis was used to determine the wealth index/socioeconomic categories. T-test was used to determine differences in continuous data between the study groups and Chi-square test used to determine associations in categorized variables between the study groups. Wilcoxon test was used to determine differences in food frequencies between the study groups while GPAQ was used to analyze physical activity levels. Multiple regression was used to determine predictors of elevated HbAlc. On the whole, at baseline, the participants had high fasting blood sugar with low serum chromium levels. Chromium supplementation significantly reduced HbAlc (DID: intervention 1.44% versus control -0.79%; p=0.001) and LDL elevation (DID: intervention -0.09 mmol/l versus control -0.91 mmol/l; t-test; p=0.010). Chromium supplementation had no effect on BMI, WC and W/H ratio; no effect on chromium status (t-test; p=0.241), triglycerides (t-test; p=0.648) and HDL (t-test; p=0.648). The predictors for elevated (above 9%) HbAlc were age and fasting blood sugar; the higher the fasting blood sugar and the older the patients, the higher the likelihood of elevated HbAlc. Since chromium supplementation was effective in reducing HbAlc and LDL among Type 2 diabetics in this study; it is recommended that chromium is used in management of blood sugar in Type 2 Diabetes.
Development and utilization of amaranth sorghum Grains product to enhance the Nutritional status of moderately malnourished Children in Thika District
(Kenyatta University, 2014) Okoth, Judith Kanensi
Poor complementary foods are a major cause of undernutrition in sub-Saharan Africa. Thin porridge prepared predominantly from cereals and starchy tubers is a common complementary food. Such porridge is low in energy and nutrient density and may be high in anti nutrients thus not providing the child's requirements. Infants at this stage of rapid development have high requirements of energy and nutrients per unit body weight. There is need therefore to develop nutrient-dense complementary foods that will provide adequate nutrients for the children. The main objective of this study was to develop a nutrient-dense complementary food from amaranth and sorghum grains then determine its effect on the nutritional status of moderately acutely malnourished (MAM) children 6 to 23 months old. Amaranth grain has high biological value proteins and a better amino acid profile than other staples. It is not commonly used as a complementary food in Kenya. Amaranth and sorghum grains were steeped and germinated for various periods to get the optimum steeping and germination time that would result in best nutrient composition and least antinutrients content. Product formulation was done and its nutritional value determined by proximate analysis. The effect of the developed food product in rehabilitating MAM children was tested using a randomized controlled study, at Kiandutu slum, Thika. The study had two arms: control group (CG) in which children received maize-sorghum flour and the treatment group (TG) received the developed flour. The sample size per study group was 73 mother-child pairs. The children in the TG received Kcal 1000 worth of porridge per day while those in the CG received Kcal 266.8. Mothers of children in both groups were given nutrition education at baseline and monthly for six months. Anthropometric measurements, morbidity and food intake data were taken at baseline, then monthly for six months. Product acceptability was determined through focus group discussions and questionnaires administered to the mothers. Descriptive statistics were used to describe the study population in terms of food security, morbidity, nutrient intake and children's nutritional status. The effect of the developed food product in rehabilitating MAM children was tested by Relative Risk and Mann Whitney U tests. Amaranth grains steeped for 5 hours and germinated for 24 hours had the least dry matter loss and best nutritional quality. Sorghum grains had optimal antinutrient reduction after steeping for 24 hours and germination for 72 hours. The formulation with a ratio of 90 to 10 amaranth to sorghum grains provided jhe highest energy (5 kcal per gram on dry weight basis) content. At baseline characteristics of the two groups were similar. On a monthly basis, nutrient intake in the TG was significantly higher for a majority of the nutrients than in the CG. At months 5 (RR=1.35, p=0.03) and 6 (RR=2.23, p
Nutrition education on iron status of primary school Pupils of Gatanga sub-county, Kenya.
(Kenyatta University, 2015) Gitau, Gladys Njura; Kimiywe Judith; Waudo, Judith N.
Anaemia can affect the cognitive function, motor performance and educational achievements of school age children as they grow and learn. Nutrition education has not been given priority in primary schools due to the busy school curriculum. Nutrition Education is concerned with changing an individual's ehaviour. It is in this light that this study was designed. The main objective of this study was to evaluate the effects of three main nutrition education facilitators on nutrition knowledge. The facilitators used were the researcher, 5 peer educators and an Agriculture Extension official using the FAO curriculum chart. A baseline survey was conducted in 12 randomly selected schools for 601 class six pupils and 67 households. All pupils' (154) in class six in the intervention schools participated in nutrition knowledge at pre and post-test, with a random sample of 89 proportionate pupils' for each school for biochemical data at baseline and 79 pupils' at endline. Questionnaires and an interview schedule were used to collect data with pre and post tests. Dietary intake, biochemical data on haemoglobin levels and stool among others were assessed. The experimental schools were Mabanda, Kigio and Kirwara and the control Gakurari. Baseline data were analyzed by use ofNutri-Survey software for nutrient analysis and Statistical Package for Social Sciences (SPSS) version 17 for descriptive and inferential statistics. The data were coded to search for emerging themes. This led to the identification of variables and concepts of iron deficiency in the children, which was crucial to the design of the corrective measures model for the interventions. On average, the mean mark in nutrition knowledge at baseline was 30.05% which was low. In the post-tests; all experimental schools significantly improved in nutrition knowledge. The peer facilitated school performed best with (51.52+24.79) marks, researcher facilitated scored (49.67+22.23), and the agriculture staff facilitated scored (39.29+9.87). The pre-test post- test improvement in the control school (29.6+ 14.0 to 31.21+12.74) was however not significant (p>0.05). A total of 31.4 % pupils were found to be anaemic after altitude adjustments at a calculated factor 0.5 for Gatanga altitude (2237m ASL). The prevalence of intestinal parasites was 63.1%; Entamoeba I' histolytica accounted for 61.3% and Ascaris lumbricoides 1.8%. Improvement in the adoption and use of the projects that enhance nutrition and health significantly occurred in the experimental schools as opposed to the control school. Pupils' haemoglobin status were not significantly different (p>0.05) between the experimental and control schools at baseline. However, notable differences in haemoglobin levels occurred in the experimental schools after the interventions. The relationship between nutrition knowledge and nutrient intake was positive and there was a significant relationship between nutrition knowledge and haemoglobin levels at p<0.05 (r=0.253, p=0.025). Anaemia and parasitic infestation were found to be a significant problem and therefore the need for comprehensive intervention strategies by all stakeholders like deworming and growing of iron rich foods. The study findings would contribute towards operationalization of the national school health policy and guidelines, the national food security and nutrition policy in prevention and control of IDA by enhancing nutrition education.
Effectiveness of mother-to-mother support groups in promoting of exclusive breastfeeding in Igembe South- Sub County, Meru County , Kenya: A Randomized Controlled Trial
(2015-05) M'Liria, Joseph Kobia
survival, growth and development because it reduces infant morbidity, mortality and ensures better nutrition outcomes. The major challenge has been the low rates of EBF globally (36%) despite the gradual increase in EBF rates in recent years. Prevalence of EBF is 32% and 18.6% in Kenya and Igembe South Sub-County the study site, respectively. Mother-to-mother support groups (MTMSGs) is a strategy used in Kenya and other countries to promote of EBF. There is scarcity of data on the effectiveness of MTMSGs in promotion of EBF in Kenya. The aim of this study was to assess the effectiveness of MTMSGs in promoting EBF in Igembe South Sub-County, Meru County, Kenya. The study adopted a cluster randomized controlled trial design in which the 3 health centres were randomly allocated on a 1:1:1 ratio to 3 study groups: 2 treatment groups and one control group (CG). In one treatment group (MES), the mothers in the MTMSGs received education support whereas in the second treatment group (MESIGA) the mothers were engaged in an income generating activity (lGAs) in addition to receiving education support. In both groups, the mothers held 7 monthly meetings, one pre-natally and six post-natally. The mothers in the control group received no education support from the research team but followed the usual irregular nutritionlhealth education at the health centre. The sample sizes for each group were: MES 88; MESIGA 82; and the control group 79 mothers. The determination of infant feeding practices was done on a monthly basis from months 1 to 6. Observations of infant feeding practices were carried out on a1O% of the study sample to verify maternal selfreported information at the interviews. Data on infant morbidity and weight measurements was collected on a monthly basis. Six focus group discussions were held to collect in-depth information on the rationale for maternal choices of infant feeding methods. The study outcome was EBF prevalence at 6 months as defined by crosssectional data based on 24-hour recall and cumulative or continuous EBF to six months. Data was entered using Epi-Enfo 3.5 software (CDC), cleaned using SPSS software Version 17.0 and analysed using SAS 9.3 software. Mothers in MESIGA and MES were two times more likely to exclusively breastfeed at 6 months compared to mothers in CG {RR=2.42; CI(1.36-4.28); (p=0.004}and {RR=1.89; CI(1.02-3.49); (p=O.033)} respectively using cross-sectional 24-hr recall data. There was no significant difference between EBF rates at 6 months in MES and MESIGA. The median duration of cumulative EBF for the CG was significantly lower at 0.68 months as compared with MES at 2.8 months and MESIGA at 3.36 months (p=O.OOl). IGAs significantly (p
Efficacy of Sorghum Peanut Blend in The Treatment of Moderate Acute Malnutrition in Children Aged 6 - 59 Months in Karamoja Sub-Region, Uganda
(Kenyatta University, 2015) Amegovu, A. K.
Moderate acute malnutrition (MAM) is estimated to affect 11% of children worldwide. In Sub-Saharan Africa, 239 million people are malnourished with 48 million of these being children. Karamoja region has the highest cases of acute malnutrition in Uganda. Corn Soya Blend Plus (CSB+) is the traditional treatment for moderate acute malnutrition (MAM) in children 6-59 months. CSB+ was introduced as a substitute for CSB but does not provide a sustainable treatment for moderate acute malnutrition (MAM) due to unavailability to local communities and its high cost. Despite the availability of local foods to constitute dietary supplements for children that are relatively cheaper than CSB+ and with greater potential to provide a more sustainable solution to treat MAM, they are not widely promoted. There is need therefore to formulate food supplements from locally grown foods and to test their efficacy in treating MAM among children 6-59 months of age. The study was conducted in Karamoja region, Northern Eastern Uganda. The study was conducted in two phases: phase I involved formulating a test food supplement from sorghum and peanut, mixed with honey and ghee (SPB) along with assessing its nutritional and anti- nutrient profile. Phase II comprised the intervention, in which the acceptability and efficacy of SPB versus CSB+ in treating MAM was tested. The sample size for efficacy study was 440 children, 220 for each study arms; SPB and CSB+. A randomised single-blind parallel cluster trial was conducted in which two health centres were assigned on a 1:1 ratio by computer to the two study groups. Each child received a daily ration of 269g of either SPB or CSB+ for a maximum period of 3 months. Anthropometric measurements were taken on a bi-weekly basis. The primary outcomes were the recovery rate and the mean length of stay in the programme before full recovery. Data was analysed using (SPSS version 17). Levels of macronutrients, CSB+ had significantly higher amounts of protein and carbohydrates whereas SPB had significantly higher amounts of fat and crude fibre. There was no significant difference in terms of energy content in SPB and CSB+. Proximate components, beta-carotene, iron, zinc, calcium, magnesium, phosphorus, potassium, manganese and sodium amounts were available in adequate amounts in both products. Vitamin A level was higher in CSB+ than SPB. Levels of anti- nutrients; condensed tannin, phytates, and trypsin inhibitors were significantly higher in SPB but were in amounts lower than the acceptable limits. Aflatoxins were also below the 20ppb upper limits by FDA. The two food supplements were acceptable to the study participants in terms of all the sensory attributes. The recovery rates were not significantly different (91.4%) in the SPB and 87.1% in the CSB+ group (Chi-square test; P=0.193). Duration of recovery was significantly shorter for CSB+ group; median 43 days compared to 57 days in the SPB (Kaplan-Meir Survival test). The recovery rate and the duration of stay in the programme for those children fed on CSB+ and those on SPB were all within the acceptable Sphere Standards 2004 (≥75% and ≤90 days) respectively. The cost of SPB was much lower than the CSB+ if transportation costs are considered. SPB has the potential to become a cost-effective, sustainable locally-available home-based food supplement for treatment of MAM in the study community and other similar circumstances.
Nutrition Education on Iron Status of Primary School Pupils of Gatanga Sub-County, Kenya
(Kenyatta University, 2015) Gitau, Gladys Njura
Anaemia can affect the cognitive function, motor performance and educational achievements of school age children as they grow and learn. Nutrition education has not been given priority in primary schools due to the busy school curriculum. Nutrition Education is concerned with changing an individual’s behaviour. It is in this light that this study was designed. The main objective of this study was to evaluate the effects of three main nutrition education facilitators on nutrition knowledge. The facilitators used were the researcher, 5 peer educators and an Agriculture Extension official using the FAO curriculum chart. A baseline survey was conducted in 12 randomly selected schools for 601 class six pupils and 67 households. All pupils’ (154) in class six in the intervention schools participated in nutrition knowledge at pre and post-test, with a random sample of 89 proportionate pupils' for each school for biochemical data at baseline and 79 pupils’ at endline. Questionnaires and an interview schedule were used to collect data with pre and post tests. Dietary intake, biochemical data on haemoglobin levels and stool among others were assessed. The experimental schools were Mabanda, Kigio and Kirwara and the control Gakurari. Baseline data were analyzed by use of Nutri-Survey software for nutrient analysis and Statistical Package for Social Sciences (SPSS) version 17 for descriptive and inferential statistics. The data were coded to search for emerging themes. This led to the identification of variables and concepts of iron deficiency in the children, which was crucial to the design of the corrective measures model for the interventions. On average, the mean mark in nutrition knowledge at baseline was 30.05% which was low. In the post-tests; all experimental schools significantly improved in nutrition knowledge. The peer facilitated school performed best with (51.52+24.79) marks, researcher facilitated scored (49.67+22.23), and the agriculture staff facilitated scored (39.29+9.87). The pre-test post- test improvement in the control school (29.6+14.0 to 31.21+12.74) was however not significant (p>0.05). A total of 31.4 % pupils were found to be anaemic after altitude adjustments at a calculated factor 0.5 for Gatanga altitude (2237m ASL). The prevalence of intestinal parasites was 63.1%; Entamoeba histolytica accounted for 61.3% and Ascaris lumbricoides 1.8%. Improvement in the adoption and use of the projects that enhance nutrition and health significantly occurred in the experimental schools as opposed to the control school. Pupils’ haemoglobin status were not significantly different (p>0.05) between the experimental and control schools at baseline. However, notable differences in haemoglobin levels occurred in the experimental schools after the interventions. The relationship between nutrition knowledge and nutrient intake was positive and there was a significant relationship between nutrition knowledge and haemoglobin levels at p<0.05 (r=0.253, p=0.025). Anaemia and parasitic infestation were found to be a significant problem and the need for comprehensive intervention strategies by all stakeholders like deworming and growing of iron rich foods. The study findings would contribute towards operationalization of the national school health policy and guidelines, the national food security and nutrition policy in prevention and control of IDA by enhancing nutrition education.